The only significant structure specific to this approach not mentioned for the retromandibular approach is the great auricular nerve. This sensory nerve begins deep in the neck as spinal roots C2 and C3, which fuse on the scalene muscle to form the great auricular nerve. As the nerve becomes more superficial, it emerges through the deep fascia of the neck at the middle of the posterior border of the sternocleidomastoid muscle. It crosses the sternocleidomastoid muscle at a 45o angle toward the angle of the mandible, covered only by the superficial musculoaponeurotic layer (SMAS) and skin. The nerve lies behind the external jugular vein. The nerve then may split into two branches as it courses superiorly toward the lobe of the ear (Fig. 11-1). Some branches pass through the parotid gland and supply the skin of a part of the outer ear of a variably wide area in the region of the mandibular angle.
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